module 2: epidemiology of tuberculosis facilitation tips · module 2: epidemiology of tuberculosis...
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Module 2: Epidemiology of Tuberculosis
Facilitation Tips
Background
Epidemiology is the study of diseases and other health problems in groups of people. Epidemiologists determine the frequency and pattern of health problems in different communities. In other words, they find out who has a specific health problem, how often the problem occurs, and where the problem occurs. Using this information about who, when, and where, epidemiologists try to determine why the health problem is occurring. Public health officials use epidemiologic information to design ways to prevent and control diseases in the community. By finding out who is at risk for a specific health problem, they can target their prevention and control strategies to people who are at risk. This module examines recent trends in TB in the United States and describes groups of people who are at higher risk for latent TB infection (LTBI) and TB disease. Groups of people who are at higher risk for TB varies from area to area; state and local health departments are responsible for determining specifically who is at risk in their area.
Learning Objectives
After this presentation, participants will be able to 1. Describe how the number of TB cases reported in the United States has changed over the
last 50 years 2. List five factors that contributed to the increase in the number of TB cases between 1985
and 1992 3. List three improvements TB programs were able to make with increased federal, state,
and other funds and resources that have contributed to a decrease in TB cases since 1993 4. List the groups of people who are more likely to be exposed to or infected with M.
tuberculosis 5. List the groups of people who are more likely to develop TB disease once infected with
M. tuberculosis
Module Overview
Time Activity Content Slides
5 min. Presentation Introduction Slides 1-3 10 min. Presentation Epidemiology of TB Slides 4-19 5 min. Presentation TB Case Rate Slides 20-25
25 min. Presentation People at High Risk for Becoming Infected with Mycobacterium tuberculosis Slides 26-53
10 min. Presentation People at High Risk for Developing TB
Disease After Infection with Mycobacterium tuberculosis
Slides 54-64
5 min. Case Studies Case Studies Slides 65-67 60 min. Total Time
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Facilitation Tips
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- Introduce Module 2
- Ask participants if they know what
epidemiology is
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- State objectives of presentation
Background and Objectives - Module 2, p. 1
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- Review slide content
1
2
Self-Study Modules
on Tuberculosis
Epidemiology
of Tuberculosis
Module 2 – Epidemiology of Tuberculosis 2
Module 2: ObjectivesAt completion of this module, learners will be able to:
1. Describe how the number of TB cases reported in the U.S has changed over the last 50 years
2. List 5 factors that contributed to the increase of TB cases between 1985 and 1992
3. List 3 improvements TB programs made with increased funds that have contributed to a decrease in TB cases since 1993
4. List groups of people who are more likely to be exposed to or infected with M. tuberculosis
5. List groups of people who are more likely to develop TB disease once infected with M. tuberculosis
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- Introduce section
Epidemiology of TB - Module 2, pp. 3-5
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- Ask for a volunteer to read the definition of
epidemiology
Epidemiology - Module 2, p. 2
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- Review slide content
Epidemiology - Module 2, p.1
4
Epidemiology of TB
Module 2 – Epidemiology of Tuberculosis 5
Epidemiology is the study of the distribution and causes of disease and other health problems in different groups of people.
Epidemiology (1)
Module 2 – Epidemiology of Tuberculosis 6
• Epidemiologists:
– Determine frequency and pattern of health problems in communities
– Try to figure out why health problems are occurring
Epidemiology (2)
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- Before showing slide, ask how many people in
the world are infected with TB
- State that 1/3 of the world’s population is infected with TB
- Review slide content
Global Epidemiology of TB - Module 2, p.3
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- Review slide content Note: Information regarding the RVCT is not provided in the
Self-Study Modules. For more information, please visit: www.cdc.gov/tb/publications/factsheets/statistics/rvct.htm
TB Reporting in the U.S. - Module 2, p. 3
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- Review slide content
- Emphasize that from 1953-1984 TB cases were
declining
- Explain that one of the main reasons for this decline was that TB treatment drugs were discovered in the 1940s and 1950s
U.S. Epidemiology of TB - Module 2, p. 3
Module 2 – Epidemiology of Tuberculosis 7
• TB is one of the leading causes of death due to infectious disease in the world
• Almost 2 billion people are infected with M. tuberculosis
• Each year about:
– 9 million people develop TB disease
– 2 million people die of TB
Global Epidemiology of TB
Module 2 – Epidemiology of Tuberculosis 8
• The Report of Verified Case of Tuberculosis (RVCT) is the national TB surveillance data collection form and is used for reporting all verified TB cases to CDC
– The 50 states, District of Columbia, New York City, Puerto Rico, and 7 other jurisdictions in the Pacific and Caribbean report TB cases to CDC
• Health care providers are required by law to report TB cases to state or local health departments
TB Reporting in U.S.
Module 2 – Epidemiology of Tuberculosis 9
• 1953: – More than 84,000 cases of TB
• 1953-1984: – TB cases declined about 6% each year
• 1985: – TB cases reached a low of 22,201
• 1986: – Significant increase in TB cases began
U.S. Epidemiology of TB1953 - 1986
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- Review slide content - Call attention to the increase in TB cases on
the graph (1980s)
- Ask participants why they think there was 20% increase in TB cases in the 1980s
U.S. TB Resurgence - Module 2, p. 4
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- Explain that there were several contributing
factors to the TB resurgence in the U.S.
- Review slide content
U.S. TB Resurgence - Module 2, p. 4
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- Review slide content - Stress that prevention and control efforts must
be maintained in order to prevent another resurgence
U.S. TB Control and Prevention - Module 2, p. 5
Module 2 – Epidemiology of Tuberculosis
10,00012,00014,00016,00018,00020,00022,00024,00026,00028,000
1982 1986 1990 1994 1998 2002 2008
20% increase
No.
of C
ases
Reported TB Cases, U.S., 1982-2008
Year
U.S. TB Resurgence (1)1986 - 1992
10
Module 2 – Epidemiology of Tuberculosis 11
• Contributing factors:
– Inadequate funding for TB control programs
– HIV epidemic
– Increased immigration from countries where TB is common
– Spread of TB in homeless shelters and correctional facilities
– Increase and spread of multidrug-resistant TB (MDR TB)
U.S. TB Resurgence (2)1986 - 1992
Module 2 – Epidemiology of Tuberculosis 12
• 1993-2008:
– Number of TB cases reported annually in U.S. steadily declined
• Increased federal funds and other resources allowed TB programs to improve control efforts to:
– Promptly identify persons with TB
– Start appropriate initial treatment for TB cases
– Ensure patients complete treatment
U.S. TB Control and Prevention (1) 1993 - 2008
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- Call attention to the decrease in TB cases on
the graph (after 1993) - Explain that TB cases have steadily declined
each year since 1993 - State that there were 12,904 TB cases in the
U.S. in 2008
U.S. TB Control and Prevention - Module 2, p. 5
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- Explain that despite national trends reflecting a
steady decline in the number of TB cases reported annually, there remain several areas of ongoing challenges in TB control
- Review slide content
Continuing Challenges in TB Control - Module 2, p. 5
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- Introduce study questions
- Ask participants to turn to p. 6 (if participants
have print-based modules) - Ask for a volunteer to read question - Ask participants for answers
Answers - Module 2, p. 26
Module 2 – Epidemiology of Tuberculosis 13
No.
of C
ases
Year
Reported TB Cases, U.S., 1982-2008
50% decrease
U.S. TB Control and Prevention (2)1993 - 2008
10,00012,00014,00016,00018,00020,00022,00024,00026,00028,000
1982 1986 1990 1994 1998 2002 2008
Module 2 – Epidemiology of Tuberculosis 14
• TB is reported in almost every state and is increasing in some areas
• More than half of all TB cases in the U.S. are among foreign-born residents
• TB affects racial/ethnic minorities disproportionately
• MDR TB and extensively drug-resistant TB (XDR TB)
Continuing Challenges in TB Control
Module 2 – Epidemiology of Tuberculosis 15
Epidemiology of TBStudy Question 2.1
What happened to the number of TB cases in the United States between 1953 and 1984?(pg. 6)
From 1953 - 1984, the number of TB cases reported in the U.S. decreased by an average of 6% each year.
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- Ask for a volunteer to read question
- Ask participants for answers
Answers - Module 2, p. 26
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- Ask for a volunteer to read question
- Ask participants for answers
Answers - Module 2, p. 26
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- Ask for a volunteer to read question
- Ask participants for answers
Answers - Module 2, p. 26
Module 2 – Epidemiology of Tuberculosis 16
Epidemiology of TBStudy Question 2.2
What happened to the number of TB cases in the United States between 1985 and 1992?(pg. 6)
From 1985 - 1992, the number of new TB cases increased by 20%.
Module 2 – Epidemiology of Tuberculosis 17
Name 5 factors that may have contributed to the increase in the number of TB cases between 1985 and 1992. (pg. 6)
• Inadequate funding for TB control and other public health efforts
• HIV epidemic
• Increased immigration from countries where TB is common
• Spread of TB in certain settings (e.g., correctional facilities and homeless shelters)
• Spread of MDR TB
Epidemiology of TBStudy Question 2.3
Module 2 – Epidemiology of Tuberculosis 18
Epidemiology of TBStudy Question 2.4
What has been happening to the number of TB cases in the United States since 1993?(pg. 6)
Since 1993, there has been a steady decline in the number of TB cases reported annually in the United States.
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- Ask for a volunteer to read question
- Ask participants for answers
Answers - Module 2, p. 26
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- Introduce section
- Ask what a TB case rate is and how it is
calculated
TB Case Rate - Module 2, pp. 7-8
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- Review slide content
TB Case Rate - Module 2, p. 7
Module 2 – Epidemiology of Tuberculosis 19
Epidemiology of TBStudy Question 2.5
Name 3 improvements TB programs were able to make with increased federal funds that contributed to the decrease in TB cases since 1993. (pg. 6)
• Promptly identify persons with TB
• Start appropriate initial treatment for TB cases
• Ensure patients complete treatment
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TB Case Rate
Module 2 – Epidemiology of Tuberculosis 21
• A case rate is the number of TB cases at a certain place and time, divided by size of the population at that time
• Often expressed in terms of a population size of 100,000 persons
TB Case Rate (1)
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- Use the example on slide to demonstrate how
to calculate a case rate
Note: Slide reflects 2008 surveillance data.
TB Case Rate - Module 2, p. 7
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- Explain that this map shows TB case rates by
state - Ask which states had higher rates and which
had lower rates
- Point out the case rates for your area
Note: Slide reflects 2008 surveillance data.
TB Case Rate - Module 2, p. 7
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- Review slide content
- Ask which groups have higher TB case rates
TB Case Rate - Module 2, p. 8
Module 2 – Epidemiology of Tuberculosis 22
TB Case Rate (2)Example:
• In the U.S. in 2008, there were 12,904 new TB cases in a population size of 304,059,724
12,904 x 100,000 = 4.2304,059,724
• In 2008, the U.S. TB case rate was 4.2 TB cases per 100,000 persons
Module 2 – Epidemiology of Tuberculosis 23
TB Case Rates by State, 2008
< 3.5* (year 2000 elimination target)
3.6–4.2
> 4.2 (national average)
D.C.
* Cases per 100,000
Module 2 – Epidemiology of Tuberculosis 24
• Health departments, CDC, and others can compare the occurrence of TB in different places, time periods, and groups of people using case rates
• Comparisons have shown that rates of TB are higher in certain groups than in others
– Groups with higher rates of TB are considered “high-risk” groups
TB Case Rate (3)
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- Review slide content
High-Risk Groups - Module 2, p. 8
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- Introduce section
- Ask participants who they think should be
considered at high risk for TB infection
People at High Risk for Becoming Infected with Mycobacterium tuberculosis - Module 2, pp. 9-15
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- Review slide content
People at High Risk for TB Infection - Module 2, p.8
Module 2 – Epidemiology of Tuberculosis 25
• High-risk groups can be divided into two categories:
– High risk for becoming infected with M.
tuberculosis
– High risk for developing TB disease after infection with M. tuberculosis
High-Risk Groups
26
People at High Risk for Becoming Infected with
Mycobacterium tuberculosis
Module 2 – Epidemiology of Tuberculosis 27
People at High Risk for TB Infection
• Close contacts
• Foreign-born persons
• Low-income groups and homeless persons
• Individuals who live and/or work in special settings
• Health care workers who serve high-risk groups
• Racial and ethnic minorities
• Infants, children, and adolescents
• People who inject drugs
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- Review slide content
Close Contacts – Module 2, p. 9
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Module 2 – Epidemiology of Tuberculosis 29
High-Risk Groups for TB Infection (2)Foreign-Born/Immigrants
In the U.S., LTBI and TB disease often occur among people born in areas of the world where TB is common:
– Asia– Africa– Russia– Eastern Europe– Latin America
- Review slide content
- Explain that the pie chart shows the overall
distribution of the countries of birth of foreign-born persons reported with TB in 2008 in the U.S. The top 7 countries are highlighted.
- Ask which of these foreign-born groups live in
the participants’ areas
Foreign-Born/Immigrants – Module 2, p. 9
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- Explain that the two pie charts show the
percentage of TB cases by foreign-born and U.S. born persons in 1992 and 2008
- Explain that the percentage of TB cases in the
U.S. that are among foreign-born persons has increased over the years (27% in 1992 vs. 59% in 2008)
Note: Slide reflects 2008 surveillance data.
Foreign-Born/Immigrants – Module 2, p. 9
Module 2 – Epidemiology of Tuberculosis 28
High-Risk Groups for TB Infection (1)Close Contacts
• Close contacts are people who spend time with someone who has infectious TB disease
• May include: – Family members– Coworkers– Friends
• On average, 20 – 30% of close contacts become infected with TB
Cases of TB in foreign-born and U.S.-born, 1992 and 2008
Module 2 – Epidemiology of Tuberculosis
1992
High-Risk Groups for TB Infection (3)Foreign-Born/Immigrants
U.S.-born41%
Foreign-born59%
2008
U.S.-born73%
Foreign-born27%
Foreign-born59%
U.S.-born41%
30
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- Review slide content
Foreign-Born/Immigrants – Module 2, pp. 9-10
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- Review slide content
- Explain that health departments are notified of
immigrants who are suspected of having TB. This notification system allows health departments to assist patients to receive a medical evaluation.
Foreign-Born/Immigrants – Module 2, p. 10
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- Review slide content
Foreign-Born/Immigrants – Module 2, p. 10
Module 2 – Epidemiology of Tuberculosis 31
• To address high rates of TB in foreign-born persons, CDC and other public health organizations are:
– Improving the screening process for immigrants and refugees
– Strengthening the notification system that alerts health departments about the arrival of immigrants and refugees with suspected TB disease
– Testing recent arrivals from countries where TB is common for LTBI and ensuring completion of treatment
High-Risk Groups for TB Infection (4)Foreign-Born/Immigrants
Module 2 – Epidemiology of Tuberculosis 32
High-Risk Groups for TB Infection (5)Foreign-Born/Immigrants
• Individuals applying for immigration and refugee status from overseas:
– Must be screened for TB by panel physicians before entering U.S.
– Must have completed treatment before entering U.S. if diagnosed with active TB
Module 2 – Epidemiology of Tuberculosis 33
High-Risk Groups for TB Infection (6)Foreign-Born/Immigrants
• Immigrants in U.S. applying for permanent residence or citizenship:
– Must be tested for LTBI and evaluated for TB disease by U.S.- based civil surgeons
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- Before showing slide, ask why low-income and
homelessness put people at high risk for TB infection
- Review slide content
Low-Income and Homeless – Module 2, p.10
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- Review slide content
Special Settings – Module 2, p. 11
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- Review slide content
Special Settings – Module 2, p. 11
Module 2 – Epidemiology of Tuberculosis 34
High-Risk Groups for TB Infection (7)Low-Income and Homeless
• Low-income is linked to higher risk of exposure
• Possible reasons include factors associated with low-income:– Inadequate living
conditions– Crowding– Malnutrition– Poor access to health
care
• In 2008, about 6% of TB patients were homeless
Module 2 – Epidemiology of Tuberculosis 35
• Special settings include congregate and residential settings:
– Nursing homes– Correctional facilities– Health care facilities – Homeless shelters– Drug treatment centers
High-Risk Groups for TB Infection (8)Special Settings
Module 2 – Epidemiology of Tuberculosis 36
• Risk of exposure to TB is higher than in other settings
• Risk is higher if facility is crowded
High-Risk Groups for TB Infection (9)Special Settings
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- Before showing slide, ask why groups in
correctional settings are at higher risk for TB infection
- Review slide content - Explain that being infected with HIV puts
individuals at a higher risk of developing TB disease
Correctional Facilities – Module 2, p. 11
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- Review slide content
People Who Inject Drugs – Module 2, p. 11-12
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- Before showing slide, ask participants which
factors can increase the risk for health care workers
- Review slide content
- Explain that facilities with a high risk of TB transmission should ensure appropriate TB prevention and control measures are taken
- Note that infection control procedures are
discussed more in Module 5
Health Care Workers – Module 2, p. 12
Module 2 – Epidemiology of Tuberculosis 37
• Higher risk in correctional facilities may be due to:
– Inmates who already have TB infection are at higher risk to develop TB disease
– Increasing number of inmates are infected with HIV
– Overcrowded facilities promoting the spread of TB
High-Risk Groups for TB Infection (10)Correctional Facilities
Module 2 – Epidemiology of Tuberculosis 39
High-Risk Groups for TB Infection (12) Health Care Workers
• Might be exposed to TB at work
• Risk depends on:– Number of persons
with TB in facility
– Job duties
– Infection control procedures
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- Review slide content
- Note that the number of reported TB cases in
children have been decreasing since 1993
Note: In Module 2, print-based version, Children and Adolescents are after the Racial and Ethnic Minorities
section.
Children and Adolescents – Module 2, p. 15
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- Review slide content
- Ask why TB rates might be higher for certain
racial and ethnic minorities
Racial and ethnic minorities – Module 2, p. 12
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Hispanic or Latino(29%)
Black orAfrican American
(25%)
Asian(26%)
White(17%)
American Indian orAlaska Native (1%)
Native Hawaiian orOther Pacific Islander (<1%)
*All races are non-Hispanic. Persons reporting two or more races accounted for less than 1% of all cases.Reported TB cases by race and ethnicity, U.S, 2008*
High-Risk Groups for TB Infection (15)Racial and Ethnic Minorities
42
- Explain that this pie chart shows the reported
TB cases in the U.S. in 2008 by race and ethnicity
- Ask participants which groups made up the
greatest percentage of TB cases, and which groups made up the least
Note: Slide reflects 2008 surveillance data.
Racial and Ethnic Minorities – Module 2, p. 13
Module 2 – Epidemiology of Tuberculosis 40
High-Risk Groups for TB Infection (13)Children and Adolescents
• High risk if exposed to adults in high-risk groups
• If a child has TB infection or disease, it suggests that:
– TB was transmitted recently– Person who transmitted TB
to child may still be infectious
– Others may have been exposed
Module 2 – Epidemiology of Tuberculosis 41
• TB affects certain racial and ethnic minorities disproportionately
• In 2008, about 83% of TB cases in U.S. were among racial and ethnic minorities
• Percentage of TB cases in racial and ethnic minorities is higher than expected based on percentage of these minorities in U.S. population
High-Risk Groups for TB Infection (14)Racial and Ethnic Minorities
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- Explain that this pie chart shows the U.S.
population broken down by race and ethnicity - Ask participants what they notice when
comparing this pie chart to the one of the previous slide (e.g., even though non-Hispanic whites make-up more than 60% of the U.S. population, they only account for 17% of the TB cases)
- Explain that this means that the percentage of
TB cases that occur in minorities is higher than expected based on their percentages in the U.S. population
Note: Slide reflects 2008 surveillance data
Racial and Ethnic Minorities – Module 2, p. 13
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- Review slide content
Racial and Ethnic Minorities – Module 2, p. 15
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- Ask for a volunteer to read the definition of
relative risk
Relative Risk for TB - Module 2, p. 14
Module 2 – Epidemiology of Tuberculosis 43
High-Risk Groups for TB Infection (16)Racial and Ethnic Minorities
Racial and ethnic groups by percentage of U.S population, 2008
Black or African American (12%)
American Indian or Alaska Native (<1%)
Native Hawaiian or other Pacific Islander (<1%)
Asian (4%)
White(66%)Hispanic or
Latino (15%)
Two or More Races (1%)
Module 2 – Epidemiology of Tuberculosis 44
• Disparities may exist due to racial and ethnic minorities having other risk factors for TB, such as:
– Birth in a country where TB is common
– HIV infection
– Low socioeconomic status
– Exposure to TB in high-risk settings
High-Risk Groups for TB Infection (17)Racial and Ethnic Minorities
Module 2 – Epidemiology of Tuberculosis 45
Relative risk is a ratio of the probability of disease occurring in one group versus
another group.
Relative Risk for TB (1)
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- Use the example on slide to demonstrate how
to calculate relative risk
Note: Slide reflects 2008 surveillance data
Relative Risk for TB – Module 2, p. 14
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- Explain that in this table all case rates are
compared to the case rate for non-Hispanic whites because non-Hispanic whites have the lowest case rate
Note: Slide reflects 2008 surveillance data
Relative Risk for TB – Module 2, p. 14
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- Introduce study questions
- Ask participants to turn to p. 16 (if participants
have print-based modules) - Ask for a volunteer to read question - Ask participants for answers
Answers - Module 2, p. 27
Module 2 – Epidemiology of Tuberculosis 46
Relative Risk for TB (2)
Example:
• The case rate for Asians is 25.6 compared to 1.1 for non-Hispanic whites. Therefore, the relative risk for Asians is about 23 times higher than non-Hispanic whites
25.6 (TB case rate for Asians) = 231.1 (TB case rate for non-Hispanic whites)
Module 2 – Epidemiology of Tuberculosis 47
Relative Risk for TB (3)Race and Ethnicity, 2008
Race/Ethnicity TB Case Rate(# of cases for every 100,000
persons )
Relative Risk
Asians 25.6 23
Native Hawaiians or Other Pacific Islanders
15.9 14
Blacks or African Americans
8.8 8
Hispanics or Latinos 8.1 7
American Indians or Alaskan Natives
6 5
Non- Hispanic Whites 1.1 1
Module 2 – Epidemiology of Tuberculosis 48
High-Risk Groups for TB Infection Study Question 2.6
Name 8 groups of people who are more likely to be exposed or infected with M. tuberculosis. (pg. 16)
• Close contacts of people known/suspected to have TB
• People who came to the U.S. within last 5 years from countries where TB is common
• Low-income groups
• People who live or work in residential facilities
• People who inject drugs
• Health care workers who serve high-risk clients
• High-risk racial or ethnic minority populations
• Infants, children, and adolescents exposed to adults in high-risk groups
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- Ask for a volunteer to read question
- Ask participants for answers
Answers - Module 2, p. 27
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- Ask for a volunteer to read question
- Ask participants for answers
Answers - Module 2, p. 27
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- Ask for a volunteer to read question
- Ask participants for answers
Answers - Module 2, p. 27
Module 2 – Epidemiology of Tuberculosis 49
What are public health agencies doing to address the high rate of TB in foreign born persons? (pg. 16)
• Improving overseas and domestic screening process of immigrants and refugees
• Strengthening the current notification system that alerts health departments about immigrants or refugees with suspected TB
• Testing recent arrivals from countries where TB is common for LTBI and ensuring completion of treatment
High-Risk Groups for TB Infection Study Question 2.7
Module 2 – Epidemiology of Tuberculosis 50
Why is the risk of being exposed to TB higher in certain settings, such as nursing homes or correctional facilities? (pg. 16)
• Many people in these facilities are at risk for TB disease
• Risk of exposure is higher if facility is crowded
High-Risk Groups for TB InfectionStudy Question 2.8
Module 2 – Epidemiology of Tuberculosis 51
What are some reasons why rates of TB disease are higher in correctional facilities?(pg. 16)
• Many inmates already have TB infection and are at a higher risk to develop TB disease
• An increasing number of inmates are infected with HIV, which means they are more likely to develop TB disease if they become infected with TB
• Overcrowded facilities promotes the spread of TB
High-Risk Groups for TB InfectionStudy Question 2.9
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- Ask for a volunteer to read question
- Ask participants for answers
Answers - Module 2, p. 27
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- Ask for a volunteer to read question
- Ask participants for answers
Answers - Module 2, p. 28
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- Introduce section
- Ask who is at high risk for developing TB
disease after infection
People at High Risk for Developing TB Disease After Infection with Mycobacterium tuberculosis –
Module 2, pp. 19-20
Module 2 – Epidemiology of Tuberculosis 52
Which racial and ethnic groups are disproportionately affected by TB? (pg. 17)
• Asians
• Native Hawaiians or Other Pacific Islanders
• Non-Hispanic blacks
• Hispanics
• American Indians or Alaska Natives
High-Risk Groups for TB InfectionStudy Question 2.10
Module 2 – Epidemiology of Tuberculosis 53
When a child has TB infection or disease, what does it tell us about the spread of TB in the child’s home or community? Name 3 things. (pg. 17)
• TB was transmitted recently
• Person who transmitted TB to the child may still be infectious
• Other adults and children in the home or community have probably been exposed to TB
High-Risk Groups for TB InfectionStudy Question 2.11
54
People at High Risk for Developing TB Disease
After Infection with Mycobacterium tuberculosis
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- Explain that anyone who has LTBI can
develop TB disease, but that some people are at higher risk than others
- Review slide content
High Risk Groups for TB Disease – Module 2, p. 19
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- Review slide content
- Explain that because HIV weakens the immune
system, people with TB infection and HIV infection are at a very high risk of developing TB disease
- Explain that the risk of developing TB disease is only 10% over a lifetime for people infected only with M. tuberculosis
People Living With HIV – Module 2, p. 19-20
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- Review slide content
Individuals with Certain Medical Conditions –
Module 2, p. 19
Module 2 – Epidemiology of Tuberculosis 55
High-Risk Groups for TB Disease (1)• People living with HIV
• People with medical conditions known to increase the risk for TB
• People infected with M. tuberculosis within past 2 years
• Infants and children younger than 4 years old
• People who inject drugs
Module 2 – Epidemiology of Tuberculosis 56
High-Risk Groups for TB Disease (2)People Living with HIV
• HIV is the strongest known risk factor for developing TB disease
• TB is the leading cause of death for people with HIV/AIDS
• Risk of developing TB disease is 7% - 10% each year for people who are infected with both TB and HIV
Module 2 – Epidemiology of Tuberculosis 57
• Prolonged therapy with corticosteroids, and other immunosuppressive therapy, such as tumor necrosis factor-alpha [TNF-α] antagonists
• Silicosis
• Diabetes
High-Risk Groups for TB Disease (3)Individuals with Certain Medical Conditions
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- Review slide content
Individuals with Certain Medical Conditions –
Module 2, p. 19
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- Review slide content
Recently Infected –Module 2, p. 19
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- Review slide content
Infants and Children –Module 2, p. 19
Module 2 – Epidemiology of Tuberculosis 58
High-Risk Groups for TB Disease (4)Individuals with Certain Medical Conditions
• Severe kidney disease
• Certain types of cancer
• Certain intestinal conditions
Module 2 – Epidemiology of Tuberculosis 59
• Individuals infected within the past 2 years are more likely to develop TB disease
• Risk of developing disease in first 2 years is 5%
• Risk over entire lifetime is 10%
High-Risk Groups for TB Disease (5) Recently Infected
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- Review slide content
People Who Inject Drugs –Module 2, p. 19
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- Introduce study questions
- Ask participants to turn to p. 21 (if participants
have print-based modules)
- Ask for a volunteer to read question - Ask participants for answers
Answers - Module 2, p. 28
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- Ask for a volunteer to read question
- Ask participants for answers
Answers - Module 2, p. 28
Module 2 – Epidemiology of Tuberculosis 61
• Higher risk of developing TB disease once infected due to:
– Greater possibility of HIV infection
– Injecting drugs may weaken immune system
High-Risk Groups for TB Disease (7) People Who Inject Drugs
Module 2 – Epidemiology of Tuberculosis 62
High-Risk Groups for TB DiseaseStudy Question 2.12
Name 5 groups of people who are more likely to develop TB disease once infected. (pg. 21)
• People living with HIV infection
• People with certain medical conditions
• People infected with M. tuberculosis within the past 2 years
• Infants and children younger than 4 years old
• People who inject drugs
Module 2 – Epidemiology of Tuberculosis 63
What is the strongest known risk factor for the development of TB disease? (pg. 21)
HIV infection is the strongest known risk factor for developing TB disease. HIV infection weakens the body’s immune system, making it more likely for a person who has TB infection to develop TB disease.
High-Risk Groups for TB DiseaseStudy Question 2.13
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- Ask for a volunteer to read question
- Ask participants for answers
Answers - Module 2, p. 28
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- Introduce case studies
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- Ask participants to turn to p. 18 (if participants
have print-based modules) - Read case study - Ask participants which factors would be
considered risk factors for each person
Answers – Module 2, p. 29
Module 2 – Epidemiology of Tuberculosis 64
High-Risk Groups for TB DiseaseStudy Question 2.14
If a person is infected with both M. tuberculosis and HIV, what are his or her chances of developing TB disease? How does this compare to the risk for people who are infected only with M. tuberculosis? (pg. 21)
• 7% - 10% each year if infected with both M. tuberculosis and HIV
• 10% over a lifetime if only infected with M. tuberculosis
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Case Studies
Module 2 – Epidemiology of Tuberculosis 66
Module 2: Case Study 2.1For each of the following people, indicate the factor(s) known to increase the risk of being exposed to or infected with TB (p. 18)
Person Factorsa) Mr. LeFevre ___ Works at a nursing home
___ Immigrated from Russia___ Rides the subway every day
b) Ms. Montoya ___ Was born in Latin America___ Has a father who had pulmonary TB
disease c) Ms. Parker ___ Volunteers in the emergency room of an
inner-city hospital___ Works in a day care center
d) Mr. Dudley ___ Was released from prison last year___ Sleeps in a homeless shelter
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- Ask participants to turn to p. 22 (if participants
have print-based modules) - Read case study - Ask participants which factors would be
considered risk factors for each person
- Ask if there are any questions about Module 2 before moving on to Module 3
Answers – Module 2, p. 30
Module 2 – Epidemiology of Tuberculosis 67
Module 2: Case Study 2.2For each of the following people, indicate the factor(s) known to increase the risk of developing TB disease once infected (p. 22)
Person Factorsa) Mr. Sims ___ Injects heroin
___ Is infected with HIVb) Mr. Allen ___ Has diabetes
___ Has high blood pressure c) Ms. Li ___ Has chest x-ray findings suggestive of
previous TB disease___ Has heart problems
d) Mr. Vinson ___ Is obese___ Became infected with M. tuberculosis 6
months ago